Social Anxiety (Social Phobia)
Overview
Phobias can affect anyone, regardless of age, sex and social background and are the most common type of anxiety disorder.[1] Approximately 12% of U.S. adults will experience social anxiety disorder at some point in their lives.[2] Phobias cause intense physical and psychological reactions, affecting one’s ability to function normally at home or in social settings.[3,4] Those suffering from severe phobias may organize their life around avoiding the thing that's causing them anxiety to try to lessen their distress levels.[5]
Types of Phobias
Phobias can be divided into 2 main categories: Simple/Specific and Complex. Social anxiety is considered a complex phobia, which tends to be more disabling than simple phobias. Complex phobias usually develop during adulthood and are often associated with a deep-rooted fear or anxiety about a particular situation or circumstance.[6]
Social phobia is an anxiety disorder in which a person has significant anxiety and discomfort related to a fear of being embarrassed, humiliated, or scorned by others in social or performance situations. Even when managing to confront this fear, people with social phobia usually:
Feel very anxious before the event or outing
Feel intensely uncomfortable throughout the event or outing
Have lingering unpleasant feelings after the event or outing
Social phobia often occurs in the following situations:
Public speaking
Meeting people
Dealing with authority figures
Eating in public
Using public restrooms
Although this disorder is often thought of as shyness, they are not the same. Shy people can be very uneasy around others, but they don't have the extreme anxiety in anticipating a social situation. Also, they don't necessarily avoid circumstances that make them feel self-conscious. In contrast, people with social phobia are not necessarily shy at all, but can be completely at ease with some people most of the time.
Social phobia disrupts normal life, interfering with career or social relationships. It often runs in families and may be happen along with depression or alcoholism. Social phobia often starts in early adolescence or even younger. Most people with social phobia will try to avoid situations that cause distress.[7]
Signs and Symptoms
Regardless of phobia type, common symptoms those with phobias exhibit include:[8]
An immediate feeling of intense fear, anxiety and panic when exposed to or even thinking about the source of your fear
Awareness that your fears are unreasonable or exaggerated but feeling powerless to control them
Worsening anxiety as the situation or object gets closer to you in time or physical proximity
Doing everything possible to avoid the object or situation or enduring it with intense anxiety or fear
Difficulty functioning normally because of fear
Physical reactions and sensations, including: sweating, trembling, shaking, rapid heartbeat, tight chest or difficulty breathing
Feeling nauseated and/or upset stomach
Dizzy, lightheadedness or fainting
Children present: tantrums, clinging, crying, or refusing to leave a parent's side or approach their fear
Causes
Research suggests that both genetic and environmental factors contribute to the start of phobias.[9] While phobias do not have a single cause, there are a number of associated factors.[10,11]
- A phobia may be associated with a particular incident or trauma
- A phobia may be a learned response that a person develops early in life from a parent or sibling (brother or sister). This is particularly the case for Specific Phobias and Social Phobias.
- Genetics may play a role – there's evidence to suggest that some people are born with a tendency to be more anxious than others
Diagnosis
A physician or mental health professional (e.g., psychiatrist or psychologist) can make a formal diagnosis of a phobia based on specific criteria in the DSM-5. This typically occurs when the specific fear interferes with one’s daily activities of school, work, or home life or is excessively upsetting.[12]
Complications
Phobias can be devastating, leading to problems that affect many aspects of life. If untreated, phobias can cause: [13]
Social isolation - Avoiding places and things one fears can cause academic, professional and relationship problems. Children with phobias are at risk of academic problems and loneliness, and may have trouble with social skills if their behaviors significantly differ from their peers.
Mood disorders - Many people with specific phobias have depression as well as other anxiety disorders.
Substance abuse - The stress of living with a severe specific phobia may lead to abuse of drugs or alcohol.
Treatment
The majority of phobias can be successfully treated and cured.[14] People with social phobia often find relief when treated with cognitive-behavioral therapy (CBT), medication, or a mix of both.[15] CBT focuses on teaching a person the specific skills to better tolerate anxiety, directly challenge their worries and gradually return to the activities they've avoided due to their anxiety. Through this process, symptoms improve as one builds on their initial success.[16] While medication is not usually used to treat phobias, it may be prescribed to help people cope with the effects of anticipatory anxiety.[17]
Self-Help Techniques
In addition to cognitive behavioral therapy (and medication at the direction and supervision of one’s physician), a person suffering from social phobias may wish to incorporate the following self-help techniques into their routine:[18]
Relaxation Techniques – A series of physical exercises that can help someone relax and have better control over their breathing, particularly during an anxiety or panic attack.
Visualization – This the combines relaxation and breathing techniques mentioned above with the mental visualization how one will successfully deal with a situation that could cause anxiety.
Self-Help Groups and/or Group Therapy – Meeting others with similar experiences and sharing ways of coping can provide enormous support for those suffering from social phobias.
For more information, click here to access an Interview with Psychologist Kevin Chapman on Panic & Social Anxiety.
Contributed by: Jennifer (Ghahari) Smith, Ph.D.
References
1 “Overview – Phobias,” NHS. (accessed 2-23-2022).
www.nhs.uk/mental-health/conditions/phobias/overview/
2 “Social Anxiety Disorder,” NIH: National Institute of Mental Health. (accessed 4-5-2022). www.nimh.nih.gov/health/statistics/social-anxiety-disorder
3 “Phobias,” Johns Hopkins Medicine. (accessed 2-22-2022).
www.hopkinsmedicine.org/health/conditions-and-diseases/phobias
4 “Specific Phobias,” Mayo Clinic. (accessed 2-22-2022).
www.mayoclinic.org/diseases-conditions/specific-phobias/symptoms-causes/syc-20355156
5 “Overview – Phobias,” NHS.
6 Ibid.
7 Johns Hopkins Medicine.
8 Mayo Clinic.
9 Johns Hopkins Medicine.
10 Ibid.
11 “Overview – Phobias,” NHS.
12 Johns Hopkins Medicine.
13 “Specific Phobias,” Mayo Clinic.
14 “Overview – Phobias,” NHS.
15 Johns Hopkins Medicine.
16 “Self Help – Phobias,” NHS. (accessed 2-23-2022).
www.nhs.uk/mental-health/conditions/phobias/self-help/
17 “Overview – Phobias,” NHS.
18 “Self Help – Phobias,” NHS.